Key result
Female sex predicts higher pacemaker requirement but not in-hospital stroke or death after aortic root replacement.
Why the study?
Poorer short-term outcomes have been reported for females after cardiovascular surgery, prompting examination of the influence of sex on outcomes after aortic root replacement.
Does female sex increase the risk of in-hospital mortality or stroke in patients undergoing aortic root replacement?
Cohort (n=848)
No
Does female sex increase the risk of in-hospital mortality or stroke in patients undergoing aortic root replacement?
Effect estimate: OR 0.59 (95% CI 0.28-1.25)
Female patients undergoing aortic root replacement have similar risks of in-hospital mortality or stroke compared to males, but a significantly higher incidence of requiring a permanent pacemaker.
PURPOSE: Poorer short-term outcomes have been described for females after cardiovascular surgery. We examined the influence of sex on the outcomes after aortic root replacement (ARR). METHODS: Medical records of 848 patients (females, n = 159/848, 19%) who underwent ARR at our center from 2005 to 2018 were retrospectively reviewed. Sex differences of the following outcomes were analyzed: the primary end point (in-hospital mortality or stro111ke), secondary end point (new requirement for permanent pacemaker), and long-term survival (median follow-up 21.4 months [interquartile range,1.3-60.0]). RESULTS: Females were significantly older (61.3 vs 58.7 [male]) with higher rates of pre-existing cerebrovascular disease (14% [22/159] vs 7% [52/689]) and previous valve intervention (20% [32/159] vs 13% [89/689]) but less myocardial infarction [1%(1/159) vs 7%(48/689)]. The surgical indication was different (aneurysm 75% [120/159] vs 87% [602/689], dissection 13% [21/159] vs 6% [41/689]; P < .01]). Females had larger average aneurysm size after controlling for body size (P ≤ .001). There was no sex difference in in-hospital mortality (3% [5/159] vs 2% [16/689]) or stroke (4% [7/159] vs 4% [29/689]). Multivariable logistic regression indicated that female sex was not an independent predictor of combined in-hospital stroke or death (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.28-1.25), confirmed by propensity score analysis. There was no difference in long-term survival (5-year survival, 90.96% vs 93.03%; P = .44). Females had higher incidence of permanent pacemaker requirement [11% (18/159) vs 6% (39/689), P = .03] and female sex was an independent predictor of permanent pacemaker requirement (OR, 2.01; 95% CI, 1.085-3.724; P = .03). CONCLUSIONS: While female patients have different baseline characteristics and indication for ARR, they are not exposed to an increased risk of in-hospital mortality or stroke. However, females experience increased incidence of permanent pacemaker requirement.
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McMullen et al. (2020) conducted a cohort in Aortic root replacement (n=848). Female sex vs. Male sex was evaluated on In-hospital mortality or stroke (OR 0.59, 95% CI 0.28-1.25). Female sex was not an independent predictor of combined in-hospital stroke or death after aortic root replacement (OR 0.59; 95% CI 0.28-1.25), but increased permanent pacemaker requirement.
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